Male Repro Pathology Flashcards
(38 cards)
What are the common conditions of prostate gland? (2)
BPH and Prostatic carcinoma
State the histological features of BPH
- proliferation of acinar and stromal tissue in nodular configuration
- hyperplastic fibromuscular stroma
- intact basal cell layer
State the pathogenesis of BPH
Type 2 5-alpha reductase converts T to DHT -> DHT binds to AR in epithelial and stromal cells -> proliferation of stromal cells & decrease in cell death of epithelial cells
State everything you know about BPH.
nodular hyperplasia of stromal and epithelial cells
- men above 50
- mainly occurs in transitional zone
- causes LUTS (voiding and filling problems)
- enlarged smooth prostate on DRE
- SYMMETRIC
- treat by 5 alpha reductase inhibitors, alpha blockers
causes urinary obstruction
IS NOT PRE-MALIGNANT DOES NOT RESULT IN PROSTATIC CARCINOMA!!!
State the histological features of prostatic cancer
- effacement of normal architecture of gland
- nuclear atypia
- infiltrative malignant cancer cells
- absent basal cells
- tumour can invade into extraprostatic fat
State everything you know about prostatic cancer.
- common in men over 50
- acinar adenocarcinoma >ductal carcinoma
- presents with LOW, LOA, lethargy
- can metastasise to bones and lymphatics -> obturator node > para-aortic LN > bloodstream
- elevated PSA levels
What is tumour staging and grading?
Staging - architecture (degree of how tumour cells mimic normal cells)
- Gleason staging
- TNM
Grading - tumour extent
State how we should treat prostatic cancer for..
1. localised disease
2. locally advanced disease
3. advanced, metastatic disease
- localised disease = radical prostatectomy
- locally advanced disease = radiotherapy
- advanced, metastatic disease = androgen deprivation therapy (orchdectomy + synthetic analogues of LHRH, AR blockers)
State the common conditions of penis and scrotum. (2)
- Condyloma acuminatum
- SCC
State the histological features of condyloma acuminatum.
- acanthosis
- koilocytosis
State everything you know about condyloma acuminatum.
- Associated with HPV 6, 11
- Occurs in penile/perineal areas
- Gross: sessile/predunculated papillary tumour
State the histological features of SCC.
- keratin pearls
- nests of tumour cells with squamous differentiation
- nuclear atypia
State everything you know about SCC.
- Associated with HPV 16, 18, poor hygiene and smoking
- Presents as slow growing and locally invasive mass
- Preceded by non-invasive precursor lesion = penile intraepithelial neoplasia (PeIN)
- Patho: Early gene coding regions of HPV genome codes for viral proteins - > E6 and E7 -> p53 and Rb respectively -> inactivation of genes -> cell proliferation
- Gross: Glans penis replaced by large truncating mass, infiltrative tumour invades into underlying erectile tissue
How do we differentiate between HPV-associated and HPV-independent SCC?
p16 immunohistochemistry!
(surrogate marker for high risk HPV infection)
State some common conditions of the testis and epididymis.
- cryptochordism
- hydrocoele
- testicular torsion
- orchitis
- germ cell tumours (seminoma, embryonal, yolk sac, choriocarcinoma, teratoma, sex-cord tumours)
- lymphoma
How do we differentiate between a communicating and non-communicating hydrocoele?
For communicating hydrocoele, th scrotal size will change in size throughout the day being larger in the day and normal sized when patient first wakes up. (fluid enters into perineal cavity through lack of obliteration of processus vaginalis)
Scrotal size remains enlarged throughout the day for non-communicating hydrocoele
When can the testicular torsion lead to an emergency?
If testicular torsion has occurred for more than 24 hours -> leads to testicular infarction and infertility
What are the common bacterias associated with infections for each group of patients? (children, sexually-active, old)
children - gram negative rods
sexually-active - chlamydia and gonorrhoea
older - E.coli, pseudomonas
State the pathogenesis of germ cell tumours.
Originate from germ cell neoplasia in-situ (GCNIS)
State the differences between seminomatous and non-seminomatous GCT.
Seminomatous:
- tumour cells resemble primordial germ cells
- slow growing, good prognosis
- lymphatic spread
- sensitive to radiotherapy
Non-seminomatous
- undifferentiated tumour cells
- poor prognosis, aggressive
- haematogenous spread
- not sensitive to radiotherapy
State the histological features of seminoma.
- polygonal tumour cells with clear cytoplasm containing glycogen
- admixed lymphocytic infiltrate
- large pleomorphic nuclei
State everything you know about seminoma.
- raised LDH, mild elevation for beta-HCG
- common in middle aged
- OCT4 positive immunohistostain
- Gross: Relatively homogenous, fleshy, lobulated, tan-cut surface
State the histological features of embryonal carcinoma.
- pleomorphic polygonal tumour cells
- high grade nuclear features
- solid, glandular, papillary growth pattern
State everything you know about embryonal carcinoma.
- common in young population
- no serum markers
- gross: solid fleshy tan-cut surface
